Pretransplantation EASIX predicts intensive care unit admission in allogeneic hematopoietic cell transplantation

Blood Advances - Tập 5 - Trang 3418-3426 - 2021
Marta Peña1,2, Maria Queralt Salas1,3, Alberto Mussetti1,2, Gabriel Moreno-Gonzalez4, Anna Bosch1,2, Beatriz Patiño1, Laura Jiménez1, Meriem Kara1, Rocío Parody1,2, Anna Sureda1,2,5
1Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
2Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
3Bone Marrow Transplant Unit, Department of Hematology, August Pi i Sunyer Biomedical Research Institute, Hospital Clinic de Barcelona, Barcelona, Spain
4Intensive Care Medicine, Bellvitge University Hospital, Barcelona, Spain
5Faculty of Medicine, University of Barcelona, Barcelona, Spain

Tóm tắt

Abstract

The Endothelial Activation and Stress Index (EASIX) is a laboratory-based prognosis index defined as creatinine × lactate dehydrogenase/platelets. When measured at pretransplantation evaluation (EASIX-PRE), it predicts allogeneic hematopoietic cell transplantation (alloHCT) mortality. This study explores its ability to predict intensive care unit (ICU) admission and validates EASIX-PRE predictive power for overall survival (OS) and nonrelapse mortality (NRM) in 167 consecutive patients undergoing alloHCT. EASIX-PRE was calculated retrospectively in all patients and transformed into log2 values (log2-EASIX-PRE). Log2-EASIX-PRE predicted ICU admission (hazard ratio [HR], 1.41; P < .001), OS (HR, 1.19; P = .011), and NRM (HR, 1.28; P = .004). The most discriminating EASIX-PRE cutoff value for risk of ICU admission was the 75th percentile (2.795); for OS and NRM, it was the median value (1.703). Patients with EASIX-PRE >2.795 had higher incidence of ICU admission in comparison with patients with lower EASIX-PRE values (day +180, 35.8% vs 12.8%; HR, 2.28; P = .010). Additionally, patients with EASIX-PRE >1.073 had lower OS (2 years, 57.7% vs 68.7%; HR, 1.98; P = .006) and higher NRM (2 years, 38.7% vs 18.5%; HR, 2.92; P = .001) than patients with lower EASIX-PRE results. Log2-EASIX-PRE was not associated with incidence of transplantation-associated microangiopathy, sinusoidal obstruction syndrome, or acute graft-versus-host disease. This study proposes EASIX-PRE as a prognostic tool to identify patients undergoing alloHCT at increased risk of severe organ dysfunction and who would therefore require ICU admission. Early identification of patients at high risk of severe events could contribute to personalized intervention design. Additionally, it validates the association between EASIX-PRE and OS and NRM in those undergoing alloHCT.


Tài liệu tham khảo

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Blood Advances

Tập 5

3418-3426

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